{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T18:46:52Z","timestamp":1769885212009,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T00:00:00Z","timestamp":1753488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100020930","name":"Ministry of Education","doi-asserted-by":"publisher","award":["24H02702"],"award-info":[{"award-number":["24H02702"]}],"id":[{"id":"10.13039\/501100020930","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In advanced chronic aortic regurgitation (AR), left ventricular (LV) volume\/pressure overload leads to LV hypertrophy and heart failure. Echocardiography often reveals gradual and continuous enlargement of the LV throughout diastole as AR adds to LV inflow. The severity, cardiac overload, and timing of therapeutic interventions in AR patients remain controversial. Here, we investigated mid-diastolic LV strain rate (SRmin) as a measure of LV load due to AR, its relationship to conventional AR measures, and its impact on surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This single-centre retrospective study included 248 patients (mean age, 73 years; 44% females) with chronic AR and LV ejection fraction (LVEF) &amp;gt; 50%, of whom 17% had moderate and 9% severe AR. SRmin values, obtained from a mean frame rate of 67\u2005Hz (61\u201371), correlated with conventional indices such as vena contracta width (r = 0.40, P &amp;lt; 0.001) and regurgitant volume (r = 0.59, P &amp;lt; 0.001) and increased with AR severity. Using an SRmin cutoff of 0.085 (1\/s) for severe AR, sensitivity and specificity were 87% (area under the curve, 0.943). The intraclass correlation coefficient for intra- and inter-observer reproducibility was both 0.97, and Bland\u2013Altman analysis revealed a mean (standard deviation) bias of 0.004 (0.027) and 0.002 (0.026) (1\/s), respectively. In 63 patients with moderate or severe AR, time to surgery was shorter in the SRmin \u2265 0.085 group [335.5 days (47.0\u20131234.0), P = 0.034] than that in the SRmin &amp;lt; 0.085 group (602.0 days [82.3\u20131038.5]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SRmin, which reflects LV load by AR, can assess AR severity and indicate the timing of therapeutic intervention in patients with preserved LVEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf218","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T11:43:25Z","timestamp":1753443805000},"page":"51-60","source":"Crossref","is-referenced-by-count":1,"title":["Impact of diastolic left ventricular strain rate on assessment of aortic regurgitation severity and timing of surgical intervention in patients with preserved left ventricular ejection fraction"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-5481","authenticated-orcid":false,"given":"Mayu","family":"Nakamoto","sequence":"first","affiliation":[{"name":"Division of Laboratory, Yamaguchi University Hospital , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]},{"name":"Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayumi","family":"Omuro","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Ariyoshi","sequence":"additional","affiliation":[{"name":"Ultrasound Examination Center, Department of Clinical Laboratory Sciences, Yamaguchi University Hospital , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoko","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Division of Laboratory, Yamaguchi University Hospital , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenta","family":"Kunimitsu","sequence":"additional","affiliation":[{"name":"Ultrasound Examination Center, Department of Clinical Laboratory Sciences, Yamaguchi University Hospital , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Omuro","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuaki","family":"Wada","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]},{"name":"Department of Cardiovascular Medicine, Nagoya City University East Medical Center , 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuaki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2639-5373","authenticated-orcid":false,"given":"Shinichi","family":"Okuda","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoaki","family":"Sano","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine , 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,26]]},"reference":[{"key":"2026013009123218000_jeaf218-B1","first-page":"1402","volume-title":"Braunwald Heart Disease: A Textbook of Cardiovascular Medicine","author":"Zipes","year":"2019","edition":"11th ed"},{"key":"2026013009123218000_jeaf218-B2","first-page":"442","volume-title":"ASE\u2019s Comprehensive Echocardiography","author":"Lang","year":"2016","edition":"2nd ed"},{"key":"2026013009123218000_jeaf218-B3","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2026013009123218000_jeaf218-B4","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Scientific document committee of the European Association of Cardiovascular Imaging. Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B5","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/j.jacc.2019.01.024","article-title":"Outcomes in chronic hemodynamically significant aortic regurgitation and limitations of current guidelines","volume":"73","author":"Yang","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2026013009123218000_jeaf218-B6","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1161\/CIRCIMAGING.113.001177","article-title":"Decision making in asymptomatic aortic regurgitation in the era of guidelines: incremental values of resting and exercise cardiac dysfunction","volume":"7","author":"Kusunose","year":"2014","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B7","first-page":"992","article-title":"Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis","volume":"16","author":"Ewe","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B8","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.jcmg.2017.02.016","article-title":"Incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic aortic regurgitation and preserved left ventricular ejection fraction","volume":"11","author":"Alashi","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B9","first-page":"280","volume-title":"Feigenbaum\u2019s Echocardiography","author":"Armstrong","year":"2010","edition":"7th ed"},{"key":"2026013009123218000_jeaf218-B10","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"2026013009123218000_jeaf218-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2026013009123218000_jeaf218-B12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.echo.2014.11.003","article-title":"Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI\/ASE\/industry task force to standardize deformation imaging","volume":"28","author":"Vogit","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2026013009123218000_jeaf218-B13","doi-asserted-by":"crossref","first-page":"e183","DOI":"10.1016\/j.jtcvs.2021.04.002","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"162","author":"Otto","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026013009123218000_jeaf218-B14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"2026013009123218000_jeaf218-B15","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/0002-9149(64)90027-X","article-title":"Left retrograde cardioangiography in acquired cardiac disease: technic, indications and interpretations in 700 cases","volume":"14","author":"Sellers","year":"1964","journal-title":"Am J Cardiol"},{"key":"2026013009123218000_jeaf218-B16","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.echo.2008.11.031","article-title":"Direct measurement of proximal isovelocity surface area by real-time three-dimensional color Doppler for quantitation of aortic regurgitant volume: an in vitro validation","volume":"22","author":"Pirat","year":"2009","journal-title":"J Am Soc Echocardiogr"},{"key":"2026013009123218000_jeaf218-B17","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.amjcard.2008.04.011","article-title":"Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets","volume":"102","author":"Pouleur","year":"2008","journal-title":"Am J Cardiol"},{"key":"2026013009123218000_jeaf218-B18","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.amjcard.2013.04.025","article-title":"Accuracy of three-dimensional versus two-dimensional echocardiography for quantification of aortic regurgitation and validation by three-dimensional three-directional velocity-encoded magnetic resonance imaging","volume":"112","author":"Ewe","year":"2013","journal-title":"Am J Cardiol"},{"key":"2026013009123218000_jeaf218-B19","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ejechocard\/jeq030","article-title":"European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)","volume":"11","author":"Lancellotti","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2026013009123218000_jeaf218-B20","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1540-8175.2000.tb01140.x","article-title":"Aortic regurgitation: quantitative methods by echocardiography","volume":"17","author":"Ekery","year":"2000","journal-title":"Echocardiography"},{"key":"2026013009123218000_jeaf218-B21","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/0002-9149(86)90215-8","article-title":"A simple Doppler echocardiographic method for estimating severity of aortic regurgitation","volume":"57","author":"Takenaka","year":"1986","journal-title":"Am J Cardiol"},{"key":"2026013009123218000_jeaf218-B22","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1161\/CIRCULATIONAHA.117.029858","article-title":"Early detection of subclinical myocardial damage in chronic aortic regurgitation and strategies for timely treatment of asymptomatic patients","volume":"137","author":"Lee","year":"2018","journal-title":"Circulation"},{"key":"2026013009123218000_jeaf218-B23","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/ejcts\/ezx018","article-title":"Early surgery versus conventional treatment for asymptomatic severe aortic regurgitation with normal ejection fraction and left ventricular dilatation","volume":"52","author":"Wang","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026013009123218000_jeaf218-B24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2011.01.015","article-title":"Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE\/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography","volume":"24","author":"Mor-Avi","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"2026013009123218000_jeaf218-B25","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jcmg.2017.11.017","article-title":"Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction","volume":"11","author":"Potter","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B26","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1111\/echo.14030","article-title":"The predictive value of left ventricular myocardium mechanics evaluation in asymptomatic patients with aortic regurgitation and preserved left ventricular ejection fraction. A long-term speckle-tracking echocardiographic study","volume":"35","author":"Verseckaite","year":"2018","journal-title":"Echocardiography"},{"key":"2026013009123218000_jeaf218-B27","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jcmg.2010.11.016","article-title":"Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery","volume":"4","author":"Olsen","year":"2011","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B28","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1093\/ehjci\/jes160","article-title":"Subendocardial dysfunction in patients with chronic severe aortic regurgitation and preserved ejection fraction detected with speckle-tracking strain imaging and transmural myocardial strain profile","volume":"14","author":"Kaneko","year":"2013","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B29","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jcmg.2018.12.021","article-title":"Long-term outcomes after aortic valve surgery in patients with asymptomatic chronic aortic regurgitation and preserved LVEF: impact of baseline and follow-up global longitudinal strain","volume":"13","author":"Alashi","year":"2020","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026013009123218000_jeaf218-B30","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1253\/circj.CJ-14-0360","article-title":"Three-dimensional speckle tracking echocardiography","volume":"78","author":"Seo","year":"2014","journal-title":"Circ J"},{"key":"2026013009123218000_jeaf218-B31","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jcmg.2024.08.013","article-title":"Echocardiographic evaluation of chronic aortic regurgitation: comparison with cardiac magnetic resonance and implications for guideline recommendations","volume":"18","author":"Attar","year":"2025","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeaf218\/63855280\/jeaf218.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/1\/51\/63855280\/jeaf218.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/1\/51\/63855280\/jeaf218.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T14:12:41Z","timestamp":1769782361000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/27\/1\/51\/8213981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,26]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,7,26]]},"published-print":{"date-parts":[[2026,1,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeaf218","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,7,26]]}}}